First of all, let me say that there is nothing “streamlined” about cognitive behavioral therapy. These types of solution-focused and evidence-based modalities are often more effective than traditional talk therapy because they are targeting specific cognitive thinking errors in which virtually every human being engages. Those thinking errors often lead to the dysfunctional behaviors and emotional difficulties that people find so debilitating.
For example, no competent psychotherapist in their right mind would argue that just talking about feelings in regards to a severe anxiety disorder would benefit a client in any significant way. It would be crucial to the client to receive the best treatment that has been studied and utilized exhaustively and conclusively and shown to target and treat specific challenges, such as a brain disorder like obsessive compulsive disorder, hoarding, compulsive skin picking and even depression.
Treating mental illness requires an understanding of multiple treatment modalities. To say that traditional talk therapy is very effective might be true, but it depends on the client’s goals and the psychotherapists ethical responsibility to provide the client the best opportunity to overcome the obstacles in front of them.
Whether it’s psychodynamic, rational emotive, cognitive behavioral or the myriad other types of therapy, one is not better than the other unless you know that certain types of mental illness require certain types of treatment.
The reason insurance companies and clients tend to have high regard for more solution-focused types of therapy such as cognitive behavioral therapy is that they often can show effectiveness and success in a much shorter — and therefore more cost-effective — time frame.
Many people suffering from mental illness are not in the position to see a therapist week after week, for months or even years, only to find that the therapy was not effective. People want to see results. There is definitely a place for long-term therapy, and there is a place for short-term, results-oriented treatment.
As I learned during the grueling 3,000 hours it took before I was even eligible to sit for my license to become a marriage and family therapist, we are here to treat individuals ethically and responsibly. I would find it extremely unethical to continue working with a client week after week, year after year, if both the client and myself are not moving forward and seeing progress in improving his or her mental health. Ethically I know the responsible step would be to refer the person to another psychotherapist who might be able to get to the next level with the client.
Most importantly, I believe, is that when you are struggling with mental illness, relationship challenges and other struggles that affect your quality of life, make sure to do your homework and ask questions of your potential therapist. Are they skilled in what they do? What is their experience working with a specific diagnosis of mental illness? Are they licensed by a state board to practice psychotherapy, no matter what modality?
To be licensed in California, for example, you need at least 3,000 hours of clinical counseling experience as an intern before you can become eligible to diagnose and treat mental illness as an MFT. There are plenty of people out there who hang a shingle and call themselves “doctors” without even having a license to diagnose and treat mental illness. This is not to say that an unlicensed counselor or coach can’t be very effective, but they are not bound by the same legal and ethical issues as licensed psychotherapists.
So, do your homework, and no matter what type of therapy you engage in, make sure that you ask the important questions before you engage in a therapeutic relationship. Good luck.
— Jonathan Lukas MFT is a psychotherapist specializing in cognitive behavioral therapy. He is in private practice and runs The OCD Treatment Center of Santa Barbara, working with adolescents and adults with anxiety disorders. Click here for more information or call 805.453.2347.
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